Provider Demographics
NPI:1053989285
Name:SPANGLER, TIFFANY ANN MARIE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN MARIE
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5163 ROAD 215
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45873-9513
Mailing Address - Country:US
Mailing Address - Phone:419-796-8073
Mailing Address - Fax:
Practice Address - Street 1:755 OTTAWA ST
Practice Address - Street 2:
Practice Address - City:KALIDA
Practice Address - State:OH
Practice Address - Zip Code:45853-2096
Practice Address - Country:US
Practice Address - Phone:419-532-2961
Practice Address - Fax:419-532-2962
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.464343163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator